i had one of the worst shifts i have ever had on friday. there's almost too much to explain and i feel like i couldn't make it sound bad enough. but imagine this. at one point, it got so bad, my charge nurse put his arm around me, said he was sorry my day was sucking, and that i won the award for worst day. because of his small act of kindness, i broke into hysteric sobs at the nurses station and said something like, "i hate working here. everyone dies!"
my dear friend marian stood beside me, kind of unsure how to proceed. the charge nurse, a 6 foot 2 grizzly bear of a man, also asked what he could do to lighten my load. and i decided i needed three minutes to myself in the bathroom, to cry harder and/or compose myself. as i ran off the unit, i could hear the charge RN say to marian, "follow her." so, marian and i convened in the bathroom where i proceeded to cry a bit more (and chuckled about our pow-wow in the handicapped bathroom stall). and then i peed with marian standing nearby. i've cried at work before, but i've never peed in front of a colleague. work has hit an all time low.
on my drive home, i cried some more. i cried because my 31 year old patient was told he has two weeks to live. and i cried because this 31 year old was going home, ALONE, with no one to hug her or support her and tell her that she and the world were going to be okay.
by some strange twist of fate, my friend called me on my drive home. and when i answered, he immediately could tell i was distraught. he's heard me sob before; but i think i surprised him mid-misery, instead of forewarning him with some comment like, "i had a shitty day." instead, i snotted and sniffled into the cellphone. we talked for 30 minutes or so and when our conversation was coming to a close, i decided to invite him over. he too had had a bad day at work; he has deadlines and projects galore. and for someone who is almost never phased, he seemed stressed also - i thought ice cream might cure both our ails. and to my surprise and utter delight, he thanked me for the invite and said he was looking for parking in my neighborhood. what a dear friend! he knew exactly what i needed and jumped in the car even before my invitation. i needed to not be alone. i needed a split scoop of cinnamon and maple walnut ice cream. and i needed to watch an hour of bad tv with someone by my side.
i woke up on saturday AM with swollen and puffy eyes. but the ice cream and company had "cured" a small piece of my heart the night before. and i was able to get out of bed and carry on.
Sunday, November 20, 2011
Wednesday, November 16, 2011
bathing
one of the reasons i love nursing is because i get to be a part of some of the most loving and intimate moments in peoples' lives. it's truly an honor to witness and, in some sense, be invited to participate in loving rituals and devastating goodbyes.
last week, i was called in to the ICU to help a fellow nurse clean up a patient. most folks think of nursing work as "dirty work," and it can be. but really, sometimes the "dirty" stuff leads to the most beautiful moments. the 32 year old patient, whom i had cared for weeks prior when she was very ill but not yet required ventilator assistance to breathe, needed a small bath and turn. her non-english speaking mother helped us with the bathing. in all honesty, she "dictated" what be done and how without uttering a single word. she cleaned her daughter's body as if it was the most important job in the world - every nook and cranny was washed, rinsed, and lotioned. i stood there, with two other nurses, in awe of this mother's love for her "baby."
another young woman was in the room. she sat in the corner and cried. i asked her if she was a friend of the patient and she said "no, i have never met the patient or the mother. but i am from the same country and from the same church." she came simply to show her support and in turn, ended up serving as a translator. and with me, had the opportunity to witness a very special bath - one of my patient's last. i told her to tell the patient's mother something for me - "should i ever get sick, i would like for olga to care for me." it was my way of giving her a compliment, my way of saying to olga that she was doing her best, that her love was enough (not to cure her daughter, but to envelop her daughter with love and compassion as she lay dying).
the patient died yesterday morning. and although i was not there, i know the patient was embraced by her mother's love. and for having been just a tiny part of their last moments together, i am thankful.
last week, i was called in to the ICU to help a fellow nurse clean up a patient. most folks think of nursing work as "dirty work," and it can be. but really, sometimes the "dirty" stuff leads to the most beautiful moments. the 32 year old patient, whom i had cared for weeks prior when she was very ill but not yet required ventilator assistance to breathe, needed a small bath and turn. her non-english speaking mother helped us with the bathing. in all honesty, she "dictated" what be done and how without uttering a single word. she cleaned her daughter's body as if it was the most important job in the world - every nook and cranny was washed, rinsed, and lotioned. i stood there, with two other nurses, in awe of this mother's love for her "baby."
another young woman was in the room. she sat in the corner and cried. i asked her if she was a friend of the patient and she said "no, i have never met the patient or the mother. but i am from the same country and from the same church." she came simply to show her support and in turn, ended up serving as a translator. and with me, had the opportunity to witness a very special bath - one of my patient's last. i told her to tell the patient's mother something for me - "should i ever get sick, i would like for olga to care for me." it was my way of giving her a compliment, my way of saying to olga that she was doing her best, that her love was enough (not to cure her daughter, but to envelop her daughter with love and compassion as she lay dying).
the patient died yesterday morning. and although i was not there, i know the patient was embraced by her mother's love. and for having been just a tiny part of their last moments together, i am thankful.
Tuesday, November 15, 2011
"i'm leaving. i don't care what you say. i hate it here."
i took care of that 22 year old gal yesterday, the one i mentioned last week, with a premie in the NICU in spokane. poor thing. i think she was a bit immature to start with, but then this series of disasters has seemed to set her back a bit. taking care of her is a lot like trying to rationalize with a 5 year old. it's impossible!
she is on the mend; her body has responded to the transplant in the way we hoped. her immune system has started to come back. BUT... she is still extremely vulnerable to infection. she is still on IV antibiotics, not to mention IV sugars, fats, and narcotics. she requires IV anti-nausea medication to prevent her from throwing up, and even still, she gets sick on occasion. and for some reason, she thought it was a good idea to refuse all nursing and medical care and pack up her belongings and try to leave the hospital - ALONE (since her mother was unsupportive of the idea and wouldn't pick her up).
it was an interesting experience. one that involved a lot of patience. i had to involve her primary care provider (a nice visiting doctor from somewhere with a great accent!), the attending, social work, and ME. i spent ALL morning in her room, trying to convince her to stay. having to outline ALL the risks of leaving early, against medical advice. we had to be honest - and tell her that an infection cause cause life-threatening results. and then, i had to pull the baby card, which just felt mean and horrible. but was true. "your baby is sick and needs you to be your best, healthiest self. that means you need to stay here until you are better. do you want your baby to be without a mommy?"
poor little girl. she cried. and demanded to leave anyways. and then, about 15 minutes later, called me into her room, told me she was staying, and asked me to help her get into the shower.
she is on the mend; her body has responded to the transplant in the way we hoped. her immune system has started to come back. BUT... she is still extremely vulnerable to infection. she is still on IV antibiotics, not to mention IV sugars, fats, and narcotics. she requires IV anti-nausea medication to prevent her from throwing up, and even still, she gets sick on occasion. and for some reason, she thought it was a good idea to refuse all nursing and medical care and pack up her belongings and try to leave the hospital - ALONE (since her mother was unsupportive of the idea and wouldn't pick her up).
it was an interesting experience. one that involved a lot of patience. i had to involve her primary care provider (a nice visiting doctor from somewhere with a great accent!), the attending, social work, and ME. i spent ALL morning in her room, trying to convince her to stay. having to outline ALL the risks of leaving early, against medical advice. we had to be honest - and tell her that an infection cause cause life-threatening results. and then, i had to pull the baby card, which just felt mean and horrible. but was true. "your baby is sick and needs you to be your best, healthiest self. that means you need to stay here until you are better. do you want your baby to be without a mommy?"
poor little girl. she cried. and demanded to leave anyways. and then, about 15 minutes later, called me into her room, told me she was staying, and asked me to help her get into the shower.
Thursday, November 10, 2011
compliment?
i think i got a compliment today. my patient needed a dressing change; when i asked if it could be done, he said, "are you gonna do it? or are you gonna send in one of those crackheads you work with?" i shouldn't have asked, but the question flew right out of my mouth before i could stop myself. "who do you think is a crackhead?" he proceeded to tell me the name of a nurse i work with and i had to chuckle. the nurse he mentioned is more than a bit scatterbrained, but he is kind and intelligent and more than competent enough to do a dressing change. but my patient preferred me and suggested i tell the other nurses on my unit how to scrub the hubs on his central line and how to administer his IV pain medications - fast and in large doses.
i must add, while we were having this comical conversation, my 31 year old patient lay with his eyes closed, nauseated, holding his 4 year old son's hand. after discussing the "crackheads," my patient shook his son's hand firmly and proceeded to teach him how to be a man. it was sweet. they practiced a time or two and then my patient, in a slight drug fog, tenderly touched his son's cheek. it was loving. and genuine. and oh so sad. i couldn't help but think - these lessons, on how to be a gentleman, are the only lessons this little boy will get from his daddy. my patient, the one who thinks my colleagues are crackheads, is not long for this world.
i must add, while we were having this comical conversation, my 31 year old patient lay with his eyes closed, nauseated, holding his 4 year old son's hand. after discussing the "crackheads," my patient shook his son's hand firmly and proceeded to teach him how to be a man. it was sweet. they practiced a time or two and then my patient, in a slight drug fog, tenderly touched his son's cheek. it was loving. and genuine. and oh so sad. i couldn't help but think - these lessons, on how to be a gentleman, are the only lessons this little boy will get from his daddy. my patient, the one who thinks my colleagues are crackheads, is not long for this world.
Tuesday, November 8, 2011
blah
it's been one of those weeks at work... where everything seems to go wrong. our computer charting system went down on both sunday and monday. for hours. and although i HATE charting and not being able to may sound like a good thing, it's actually really bad, more than annoying, and totally unsafe. thankfully, nothing went disasterously wrong. well, nothing that i know of. but it was a rough few days. for one of many reasons.
one of my patients is 22 years old. that's unfair enough; right? listen to the rest of her story (i don't know all of it in detail, because i couldn't get into her chart long enough to find out her entire history). but, what i do know is that this very immature 22 year old is on my unit, suffering from non-hodgkin's lymphoma. she is in the middle of her transplant, waiting for her immune system to come back after the very high doses of chemotherapy and radiation she received. but the real kicker is - she is 12 weeks post-partum. that means, 12 weeks ago, she had a baby. her baby was born at 26 weeks - barely viable - 40 weeks is term. and while she is here in seattle fighting for her life, her premie son is fighting for his in spokane.
i'm not a mother, so i can't quite imagine how traumatizing this situation must feel. but i am empathetic. and loving. and kind. and i feel devastated for this family. my 22 year old patient has no significant other; there is no boyfriend, no husband, no father to her tiny son. thankfully, she has parents. and they are supportive. but imagine their predicament - new grandparents, watching their daughter fight to survive, with the possibility of losing her and gaining an infant "son." my god the world seems unfair sometimes, huh?
one of my patients is 22 years old. that's unfair enough; right? listen to the rest of her story (i don't know all of it in detail, because i couldn't get into her chart long enough to find out her entire history). but, what i do know is that this very immature 22 year old is on my unit, suffering from non-hodgkin's lymphoma. she is in the middle of her transplant, waiting for her immune system to come back after the very high doses of chemotherapy and radiation she received. but the real kicker is - she is 12 weeks post-partum. that means, 12 weeks ago, she had a baby. her baby was born at 26 weeks - barely viable - 40 weeks is term. and while she is here in seattle fighting for her life, her premie son is fighting for his in spokane.
i'm not a mother, so i can't quite imagine how traumatizing this situation must feel. but i am empathetic. and loving. and kind. and i feel devastated for this family. my 22 year old patient has no significant other; there is no boyfriend, no husband, no father to her tiny son. thankfully, she has parents. and they are supportive. but imagine their predicament - new grandparents, watching their daughter fight to survive, with the possibility of losing her and gaining an infant "son." my god the world seems unfair sometimes, huh?
Sunday, November 6, 2011
the rocking chair
there was this patient on our unit for about two months. it's the kind of patient all nurses talk about - for both good and bad reasons. i would come in to work in the morning and secretly wish i could care for her, but would then breathe a sigh of relief when she wasn't my assignment for the day. she was a challenging person to care for, but she was so darling and her parents were so kind. her situation tugged at your heart strings and questioned your faith in medicine and fairness and all that is good in the world (if you even dared to believe in any of those things to begin with).
little lisa was 23 years old. i speak of her as though she was a child because in some sense she was. lisa had down's syndrome and strutted around our unit with attitude and sass when she was well enough. most of the time though she laid in her bed, snuggling her favorite stuffed bunny or shooting nerf hoops from the reclined position. her chemotherapy was mountain dew and the blood pressure cuff was an arm hug. she made nurses be creative and patient and appreciative.
but of course, like the rest of my patients, she got sick. super sick. and ended up being intubated and ventilated. eventually her kidneys shut down and she required dialysis. and just a few days ago, she developed a bleed in her head and a possible stroke and/or heart attack. her prognosis was dismal with intubation; hence, with the additions of numerous complications, her care became futile. her brave and kind parents decided to withdraw and allow lisa to die, with dignity and comfort.
i wasn't at work yesterday when she passed. but i heard the story. and i've cried several times since. people like lisa are often born to special people; or perhaps special people are created by folks like lisa. anyway, her father asked if he could rock lisa to sleep in a rocking chair, like he did when she was small. a fantastic nurse and good friend on my unit, nancy, made his wish possible. she went to the NICU and borrowed a rocking chair. and with the help of the respiratory therapist (who was needed to skillfully assist lisa and her many tubes into her father's lap), she transferred lisa from a giant, impersonal hospital bed to the lap of someone who loved her more than i bet he could ever have guessed. within just a few seconds of being disconnected from the ventilator, lisa slipped away. she stopped struggling to breathe (in a world that was likely challenging for her in many ways). and her parents embraced her goodbye.
little lisa was 23 years old. i speak of her as though she was a child because in some sense she was. lisa had down's syndrome and strutted around our unit with attitude and sass when she was well enough. most of the time though she laid in her bed, snuggling her favorite stuffed bunny or shooting nerf hoops from the reclined position. her chemotherapy was mountain dew and the blood pressure cuff was an arm hug. she made nurses be creative and patient and appreciative.
but of course, like the rest of my patients, she got sick. super sick. and ended up being intubated and ventilated. eventually her kidneys shut down and she required dialysis. and just a few days ago, she developed a bleed in her head and a possible stroke and/or heart attack. her prognosis was dismal with intubation; hence, with the additions of numerous complications, her care became futile. her brave and kind parents decided to withdraw and allow lisa to die, with dignity and comfort.
i wasn't at work yesterday when she passed. but i heard the story. and i've cried several times since. people like lisa are often born to special people; or perhaps special people are created by folks like lisa. anyway, her father asked if he could rock lisa to sleep in a rocking chair, like he did when she was small. a fantastic nurse and good friend on my unit, nancy, made his wish possible. she went to the NICU and borrowed a rocking chair. and with the help of the respiratory therapist (who was needed to skillfully assist lisa and her many tubes into her father's lap), she transferred lisa from a giant, impersonal hospital bed to the lap of someone who loved her more than i bet he could ever have guessed. within just a few seconds of being disconnected from the ventilator, lisa slipped away. she stopped struggling to breathe (in a world that was likely challenging for her in many ways). and her parents embraced her goodbye.
Friday, November 4, 2011
heaven or hell and why health care is stupid!
this week, i met a 43 year old woman who was diagnosed with cancer in 1993. she had osteosarcoma (cancer of the bone) and survived after receiving chemo, radiation, and having a new femur bone constructed with titanium plates and rods (of course, not without complication - she had an infection and needed screws replaced and on and on). it's now 2011, years later, and she is back in seattle (from her native north pole, alaska) with recurrence of her disease and metastises to her lungs and trachea. despite chemo and radiation, she is dying. and she is scared. and angry. and a patient on my unit.
i'll spare you the many details on how poor her admission was carried out by my night time colleagues. wait, no i won't. i can't help but mention just one of the tiny mishaps because it is SO scary and ridiculous. when i was getting report from the night nurse who admitted the patient, i asked if the patient had a tracheostomy because i saw mention of it in a physician's note. now, a tracheostomy is a hole strategically cut in the trachea or windpipe to ease with breathing (in SUPER laymens terms). i didn't ask the nurse if the patient indeed had a wart on her left pinky toe - there are just some things you don't look at or assess, especially on a night shift. but come on, you should look at your patient's HEAD. you should notice if the patient is breathing through a hole in her neck or through her mouth! but the nurse couldn't answer the question. "oh my god, did you look at your patient?"
anyway, back to why healthcare is so stupid! the patient (i will call her M) uses 2L of oxygen delivered through little straws in her nose. we have all seen little older folks carrying their tanks to help them breathe. well, M uses this too, to help alleviate some of the terrifying feelings of suffocating. as tumors fill her lungs and surround her windpipe, she constantly feels as though she is gasping for air. without oxygen, her oxygen saturation is about 92%. this is not a bad oxygen sat; it's low, but not dangerous. in the hospital, at 92%, we put people on oxygen. but, for some assinine reason, medical insurance requires that people saturate at 88% to have their home supply of oxygen covered. what that means is, M does not qualify for home oxygen (even though wearing just 2L provides her some relief). M's husband is kind, devoted, and doting. he would do anything for M. and so, he has been stealing oxygen tanks from the hospital. kind of funny, kind of sad. if your loved one felt as though they were drowning, would you steal oxygen tanks? probably!
after some sleuthing and M's husband finally revealing the source of their illegal oxygen supply, i asked if i could help them set up home oxygen legitimately. that's when M tearfully admitted that without oxygen her saturation is not low enough to qualify. my response kind of surprised M and her husband. "i don't care if you qualify legally or not. gasping for breath sounds pretty miserable. i think you deserve to have a little oxygen wherever you are if it provides you just the tiniest bit of comfort." they looked at me curiously. i was happy to document that the patient desaturated down to 88% without her oxygen; it's the least i could do. after some white-lie computer charting and a call to social work, i had a portable oxygen tank delivered to the hospital, delivered to their hotel, and set up in their home town in alaska.
does it make ANY sense that we provide futile medical treatment covered by insurance to thousands of people? on a daily basis, there are folks in the ICU on my unit that we all know will not survive. and yet, they are receiving MRIs, CT scans, dialysis, and thousands of dollars worth of nursing and medical care. BUT... we won't provide oxygen (a natural gas) to a woman who wants to die more comfortably, without gasping for air?
M and her husband thanked me profusely, as if i had performed some miracle. no nurse before me had done them this favor. as i left the hospital that night, i wondered to myself... am i going to nursing hell or nursing heaven?
i'll spare you the many details on how poor her admission was carried out by my night time colleagues. wait, no i won't. i can't help but mention just one of the tiny mishaps because it is SO scary and ridiculous. when i was getting report from the night nurse who admitted the patient, i asked if the patient had a tracheostomy because i saw mention of it in a physician's note. now, a tracheostomy is a hole strategically cut in the trachea or windpipe to ease with breathing (in SUPER laymens terms). i didn't ask the nurse if the patient indeed had a wart on her left pinky toe - there are just some things you don't look at or assess, especially on a night shift. but come on, you should look at your patient's HEAD. you should notice if the patient is breathing through a hole in her neck or through her mouth! but the nurse couldn't answer the question. "oh my god, did you look at your patient?"
anyway, back to why healthcare is so stupid! the patient (i will call her M) uses 2L of oxygen delivered through little straws in her nose. we have all seen little older folks carrying their tanks to help them breathe. well, M uses this too, to help alleviate some of the terrifying feelings of suffocating. as tumors fill her lungs and surround her windpipe, she constantly feels as though she is gasping for air. without oxygen, her oxygen saturation is about 92%. this is not a bad oxygen sat; it's low, but not dangerous. in the hospital, at 92%, we put people on oxygen. but, for some assinine reason, medical insurance requires that people saturate at 88% to have their home supply of oxygen covered. what that means is, M does not qualify for home oxygen (even though wearing just 2L provides her some relief). M's husband is kind, devoted, and doting. he would do anything for M. and so, he has been stealing oxygen tanks from the hospital. kind of funny, kind of sad. if your loved one felt as though they were drowning, would you steal oxygen tanks? probably!
after some sleuthing and M's husband finally revealing the source of their illegal oxygen supply, i asked if i could help them set up home oxygen legitimately. that's when M tearfully admitted that without oxygen her saturation is not low enough to qualify. my response kind of surprised M and her husband. "i don't care if you qualify legally or not. gasping for breath sounds pretty miserable. i think you deserve to have a little oxygen wherever you are if it provides you just the tiniest bit of comfort." they looked at me curiously. i was happy to document that the patient desaturated down to 88% without her oxygen; it's the least i could do. after some white-lie computer charting and a call to social work, i had a portable oxygen tank delivered to the hospital, delivered to their hotel, and set up in their home town in alaska.
does it make ANY sense that we provide futile medical treatment covered by insurance to thousands of people? on a daily basis, there are folks in the ICU on my unit that we all know will not survive. and yet, they are receiving MRIs, CT scans, dialysis, and thousands of dollars worth of nursing and medical care. BUT... we won't provide oxygen (a natural gas) to a woman who wants to die more comfortably, without gasping for air?
M and her husband thanked me profusely, as if i had performed some miracle. no nurse before me had done them this favor. as i left the hospital that night, i wondered to myself... am i going to nursing hell or nursing heaven?
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